Funding in Vitro Fertilization: Exploring the Health and Justice Implications of Quebec's Policy

Article excerpt

Introduction

On August 5 2010, Quebec became the only jurisdiction in North America to provide publicly funded in vitro fertilization (IVF). (1) This decision came about as a result of a campaign promise by Premier Jean Charest that if reelected on December 8 2008, the Quebec Liberal Party would modify Quebec's Health Insurance Act to include certain assisted reproductive technologies as insured medical services. (2) Pursuant to this, on June 18 2009 the National Assembly passed Bill 26, An Act respecting clinical and research activities relating to assisted procreation, (3) and then in July 2010 the Quebec government adopted two regulations, the Regulation respecting clinical activities related to assisted procreation and the Regulation to amend the Regulation respecting the application of the Health Insurance Act, (4) which collectively provide the legal and regulatory framework for this policy. (5)

Under the resulting program, the Quebec government has agreed to pay all costs related to up to three stimulated cycles, or six natural or modified natural cycles, (6) of in vitro fertilization for women of childbearing age. (7) Doctors are only permitted to transfer one embryo at a time, but exceptionally may transfer two to three if they feel that this is justified based on the embryos' quality and the patient's age. (8) The government has also stipulated that no retroactive reimbursements will be provided for medication or assisted procreation services that had been previously received. (9)

Although the motivations for this program may have been largely political, (10) proponents of this policy have pointed to its demographic, financial, health, and social benefits. The Quebec Liberal Party and Health Minister, Yves Bolduc, have emphasized that allowing free access to in vitro fertilization and related services will improve Quebec's birth rate, by allowing an estimated additional 1,500 babies to be born per year. (11) It has also been explained that funding IVF is economically sensible, as it will lower neonatal costs and the government's health care expenses, by discouraging multiple embryo implantations and reducing the number of twins, triplets and higher-order multiple births. (12) This reduction in multiple pregnancies and multiple births has also been promised to decrease the health risks associated with IVF for both mothers and their children. (13) Finally, this policy has been deemed to have positive social justice implications, as it allows individuals of various socioeconomic backgrounds to access these services. (14)

This paper will explore the health and social justice implications of this policy. It will demonstrate that although Quebec's program is laudable, it nonetheless has some limitations and may still result in negative health and justice outcomes for Quebeckers. It will argue that the Quebec government could do more to ensure the health of Quebeckers and to provide equitable support for individuals seeking to develop their families. In making these arguments this paper will contribute to the existent, albeit limited, scholarship on Quebec's controversial policy, (15) as well as to wider conversations about the potential promises and pitfalls of funding in vitro fertilization. (16)

Part I will discuss the health implications of Quebec's policy. It will explain that while this program is desirable given its ability to reduce multiple births and the health risks these entail, it should nonetheless be kept in mind that IVF may result in negative health consequences that go beyond multiple births. It will also stress that this policy will not necessarily prevent all Quebeckers from becoming pregnant with multiples as a result of assisted reproductive technologies; despite the financial incentive of state-funded reproductive services, lowered success rates for single embryo implantation or long wait times for treatment may drive some Quebeckers to seek IVF outside the province, or to make use of artificial insemination with ovarian stimulation, both of which could result in multiple gestations. …